Vertigo Unit

IMBALANCE OR INSECURITY WHILE WALKING ARE SYMPTOMS OF VERTIGO

Electronystagmography

Fig. 9

Fig. 10

España aprieta los dientes. (El País 06/08/2014)

Vertigo Unit

What is vertigo?

Vertigo is defined as the sensation that oneself or the surroundings are turning or spinning. In virtually all cases, it is accompanied by a loss of stability or loss of balance, and sometimes also by symptoms such as nausea, sweating, vomiting, etc.

Dizziness is an alteration in balance, which includes unpleasant sensations of lightheadedness, insecurity and instability, a sensation of malaise and fainting.

Oído

In other cases, loss of stability or loss of balance, combined with insecurity while walking, will be the only symptoms that present in patients.

What are the causes?

Vertigo can be associated with changes inside the ear. The most frequent types of vertigo are benign paroxysmal positional vertigo, Menière's disease and vestibular neuritis, which account for half of all doctor's visits for dizziness and vertigo.

Other alterations of the ear may include tumours (acoustic neuroma), trauma, infections, toxins (medicinal products which cause lesions in the ear) or idiopathic disorders.

Neurological causes are distinguished by their frequency and may include those of vascular origin, cervical alterations and multiple sclerosis.

Who can be affected?

Anybody can suffer from vertigo. Symptoms of stability loss can occur both during infancy and in young and elderly people. In children, these symptoms are usually related to middle ear problems accompanied by vertigo. Elderly people may experience vertigo symptoms which may progress to chronic loss of stability.

How is it diagnosed?

The first step is to ask the patient questions which lead us to a diagnosis. Particular attention is paid to limitations in everyday activities due to vertigo and the degree to which the disease affects the patient and their family.

The next step is to perform a thorough otorhinolaryngological screening, that is, of the ears, the nostrils, the mouth and the throat,

followed by:

  • A neurological screening. (Fig. 3, 4, 5, 6 and 7).
  • Audiometry or a hearing function test.

If necessary, we will add:

  • A specific screening of the balance system located inside the ear, also known as Complete Computerised Vestibular Testing.
  • Nuclear magnetic resonance imaging or computerised axial tomography (CAT) of the ear and the brain.

The combined results of the medical history and the screenings, together with audiometric testing and Complete Computerised Vestibular Testing, usually give us a precise idea of the location of the vertigo, its cause, and thus the appropriate treatment. In other cases, patients will undergo additional screening by a neurologist who specialises in vertigo.

What is Menière's vertigo?

One of the most frequent types of vertigo is called Menière's disease or syndrome. It is characterised by the presence of vertigo attacks with nausea, vomiting and sweating, accompanied by progressive hearing impairment and the perception of noises in the affected ear.

If, as is often the case, initial treatment by means of medication fails, we will proceed with a so-called "intratympanic injection of gentamicin". This takes place at our own surgery and involves the injection of a pharmaceutical product called gentamicin directly into the ear under a general anaesthetic. The objective is to administer an adequate concentration of that medicinal product to the inner ear in order to guarantee its effectiveness.

Intratympanic gentamicin is the most modern and effective treatment. It liberates 90% of patients with Menière's syndrome from vertigo attacks and allows them to lead a normal life. This technique, which is widely used in the United States, was introduced in Spain by Dr Jordi Coromina from Teknon Medical Centre.

How is vertigo treated?

The following steps are followed in the treatment of Menière's disease:

  • Initial treatment consists of pharmaceuticals only. With this treatment, 70% of patients achieve an improvement and can live a normal life.
  • If no improvement occurs, an intratympanic gentamicin treatment is administered.

Gentamicin is an antibiotic which is injected through the eardrum, passes to the inner ear and acts on the balance system. The administration of gentamicin takes place on an outpatient basis at our own surgery. The patient will have to return for a weekly follow-up, and if their symptoms have improved, the treatment will be considered as complete. This improvement consists in a progressive reduction of vertigo attacks in terms of intensity, gravity and frequency until symptoms have completely resolved. Otherwise, another dose will be applied.

In the remaining patients, who do not experience any improvement following administration of gentamicin injections, a surgical procedure will be performed:

  • During a procedure called labyrinthectomy, the inner ear is removed and the patient loses their hearing. This intervention is performed in extreme cases in which the disease itself is going to lead to deafness.
  • During a procedure called vestibular neurectomy, the balance nerve is cut in such a way that the patient's hearing can be preserved.

How are the remaining vertigos treated?

This, of course, depends on the cause of each respective vertigo:

  • Benign paroxysmal positional vertigo (bppv): This type of vertigo is triggered by an abrupt movement, especially by getting into and out of bed, turning the head to one side during a fall, overstretching the neck in order to reach something on a shelf, bending over, etc. With these movements, the patient causes irritation to the inner ear, which results in vertigo. This is due to the displacement of some cells in the inner ear which are stimulated by these movements. This type of vertigo is treated by means of a repositioning manoeuvre, which is performed at our own surgery and puts the otoliths back into their correct place. (Fig. 9 and 10)
  • Vestibular neuritis: This in an inflammatory lesion of the vestibular nerve, which causes vertigo in the patient without leading to hearing loss or ringing in the ears. It consists of a single intense attack of extended duration (3-6 days) with substantial dizziness and nausea and leads to a sensation of loss of stability for the duration of 2-3 weeks. It is treated by means of an exercise regime called "exercises for vestibular rehabilitation".

Contact details of the Vertigo Unit

Vilana Surgeries (Office 193)
T. +34 93 393 31 93

24-hour service hotline (for patients only): T. 626 11 11 95